I thank Dr Csendes for his interest in our article about the relationship between bile reflux and adenocarcinoma of the esophagus. As he points out, we focused exclusively on animal data in this article. The data were generated not only in our own laboratory but also in several other laboratories, and all the results confirm the role of bile reflux in producing adenocarcinoma in the animal model.

I personally have followed Dr Csendes' work with the Roux-en-Y gastrojejunostomy with great interest. I hope his findings are confirmed in a prospective multicenter study. In that case, the Roux-en-Y will become the standard of care for patients with Barrett syndrome, and the clinical importance of bile reflux into the esophagus will be incontrovertible. I appreciate his bringing this highly relevant work to the attention of the readers of the Archives.